Chronic Pain
Differentiating Fibromyalgia, Depression, and CFS
Understanding the relationship between chronic invisible illnesses.
Posted December 23, 2021 Reviewed by Jessica Schrader
Key points
- Fibromyalgia is characterized by chronic and widespread pain and tenderness throughout the body.
- The overall stress of living with an invisible chronic illness such as fibromyalgia can take a toll on an individual’s mood and add to anger.
- Neuroticism, which is often seen in individuals with fibromyalgia, is also known to play a role in developing depression.
Chronic physical pain, exhaustion, low energy, and depressed mood are underlying symptoms of many disorders, often leading to a puzzling diagnosis. Fibromyalgia, depression, and chronic fatigue syndrome are all very different “invisible” disorders but share similar underlying symptoms. The term “invisible” is used to describe these disorders because each of these three illnesses does not present with any physical signs visible to the naked eye. Additionally, there are no diagnostic imaging or laboratory tests for these disorders.
The relationship between chronic fatigue syndrome and depression
Chronic fatigue syndrome is also known as myalgic encephalomyelitis (ME) and is sometimes abbreviated as ME/CFS. The most recent term proposed is systemic exertional intolerance disease (SEID). It is characterized by unexplained extreme fatigue lasting for at least six months in duration that is not explained by any other underlying medical illness.
Other symptoms include:
- Non-refreshing sleep
- Difficulty with memory, focus, and concentration
- Dizziness that worsens with moving from lying down or sitting to standing
- Enlarged lymph nodes
- Headaches
- Sore throat
- Unexplained muscle/joint pain
Persistent fatigue, painful physical symptoms, sleep disturbances, poor concentration, psychomotor retardation, and decreased libido are characteristic features of both depression and chronic fatigue syndrome. As a result, individuals may be misdiagnosed with one or the other or both.
What is fibromyalgia?
Fibromyalgia is derived from the Latin term for tissue (fibro) and the Greek terms for muscle (myo) and pain (algia). Fibromyalgia is characterized by chronic and widespread pain and tenderness throughout the body and affects approximately 2% of U.S. adults (4 million people) and is most prevalent among middle-aged women. Individuals with rheumatic diseases (rheumatoid arthritis, osteoarthritis, lupus, and ankylosing spondylitis), depression, anxiety, chronic back pain, or irritable bowel syndrome are more susceptible to fibromyalgia. Fibromyalgia is diagnosed based on medical history and a physical exam that assesses tenderness to pressure at 19 points on the body. This physical exam helps health care providers rule out other causes of muscle pain. Similar to depression and chronic fatigue syndrome, fibromyalgia can't be detected using X-rays or blood tests, though health care providers might order these tests to rule out other diseases.
Is there a connection between fibromyalgia and depression?
Individuals with fibromyalgia are up to three times more likely to be diagnosed with depression at initial diagnosis and have a 74% lifetime risk of depression. The direct link between fibromyalgia and depression is not 100% known; however, symptoms of fibromyalgia such as chronic pain and tenderness often result in reduced physical activity, leading to isolation and social withdrawal. Chronic fatigue is also a symptom of fibromyalgia, which can negatively affect an individual’s mood over time. The overall stress of living with an invisible chronic illness such as fibromyalgia can take a toll on an individual’s mood and add to anger, irritability, and distractibility. Feelings of isolation, exhaustion, low energy, and frustration can also arise when individuals must navigate the confusing maze of healthcare providers when being diagnosed and treated for fibromyalgia, as most invisible chronic disorders are difficult to diagnose and require many repeated visits to different specialists. Additionally, having depression can make the fibromyalgia pain worse and result in severe fatigue and functional disability.
There are specific personality traits associated with the development of fibromyalgia that are also associated with depression. These include high harm avoidance and low self-directedness. Similarly, neuroticism, which is often seen in individuals with fibromyalgia, is also known to play a role in developing depression.
Common signs and symptoms of fibromyalgia and depression
Psychological stressors may trigger episodes of either depression or fibromyalgia, and there are several symptoms common to both disorders that are listed below:
Treatment modalities for fibromyalgia and depression
Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), are often used to treat fibromyalgia symptoms, with or without the presence of depression. Cognitive-behavioral therapy (CBT) is also used to treat both depression and fibromyalgia. The goal of CBT in this patient population is to change the mindset about pain to change how the individual deals with their pain. CBT helps to retrain thought patterns and, in doing so, can hopefully change attitudes and behaviors. The third common treatment option for depression and fibromyalgia is lifestyle modifications that encompass daily self-care routines. These include adopting good sleep hygiene patterns to help minimize fatigue and developing an exercise routine that can help alleviate chronic pain and low energy levels.
To find a therapist, please visit the Psychology Today Therapy Directory.
References
Buskila D, Cohen H. Comorbidity of fibromyalgia and psychiatric disorders. Curr. Pain Headache Rep. 11(5), 333–338 (2007).
Tennant C. Life events, stress and depression: a review of recent findings. Aust. NZ J. Psychiatry 36(2), 173–182 (2002).
Krishnan V, Nestler EJ. The molecular neurobiology of depression. Nature 455(7215), 894–902 (2008).
Guymer E, Littlejohn G. Fibromyalgia syndrome: clinical aspects and management. In: Muscle Pain: Diagnosis and Treatment. Mense S, Gerwin RD (Eds). Springer, Berlin Heidelberg, Germany, 105–141 (2010).
Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin. J. Pain 13(2), 116–137 (1997).
• Review of the temporal relationship between fibromyalgia and depression.
